Endoscopic Sinus Surgery Recovery Guide

What should I expect?

Endoscopic sinus surgery takes about 1 to 3 hours, and most people go home the same day. We do not pack the nose with gauze after sinus surgery. All of these are normal in the first week or two:

• Some bleeding from the nose for the first few days, and pink or blood-tinged drainage for several days after that.
• Nasal pain, facial pressure and congestion. Pain is usually mild and is worst in the first 2 to 3 days. You may feel more congested than you did before surgery, because of swelling and crusting inside the nose.
• Feeling tired, and a weaker sense of smell.

These improve steadily as the sinuses heal. The full benefit of surgery, such as easier breathing and a better sense of smell, usually develops over 4 to 6 weeks.

How do I rinse after surgery?

Saline rinses are the most important part of healing. They wash out old blood, mucus and crusts and keep the lining moist. The more you rinse, the less crusting needs to be removed at your post-op visit, and the better you heal.

• Start the day after surgery, unless your surgeon tells you otherwise.
• Rinse at least 4 times a day until your first post-op visit. After that, keep rinsing as your surgeon directs; many people rinse for several weeks while the lining heals.
• Use a large-volume squeeze bottle, such as a NeilMed Sinus Rinse kit from any drug store, with the saline packets that come with it. A rinse reaches the sinuses far better than a spray. Our guide How to Do a Nasal Saline Rinse shows each step.
• Use room-temperature distilled water. Tap water is not sterile, and the CDC advises against using it to rinse the nose. Sterile water, or tap water that was boiled and then cooled, is also safe.
• Let the rinse drain out on its own. Do not blow your nose for 1 week after surgery. Pink rinse water and some crusts in the first weeks are normal.
• Clean the bottle after each use with warm water and a little dish soap, rinse it well and let it air-dry. Replace it every 3 months, or sooner if it cracks or discolors.

Your surgeon will tell you whether and when to use a steroid spray, or a steroid added to your rinse.

What about bleeding?

Some bleeding from the nose is expected for the first few days, and a little oozing after rinsing or activity is normal.

• Tape a piece of gauze under your nose if there is mild bleeding, and change it as needed.
• You may use Afrin nasal spray as needed for bleeding and congestion for 3 to 5 days after surgery. Stop after 3 to 5 days, because longer use causes rebound stuffiness. Ask us first if you have high blood pressure or heart disease.
• If it bleeds, sit up and lean slightly forward (do not tip your head back), use a spray or two of Afrin, then pinch the soft lower part of the nose firmly for 15 minutes without letting go.
• Call us for bleeding that does not stop, or any bleeding that worries you. Call 911 or go to the ER for severe bleeding you cannot control, or bleeding with lightheadedness or fainting.

How should I manage pain?

Pain after sinus surgery can usually be controlled with over-the-counter medicine, and most people need little or no prescription pain medicine.

• Acetaminophen (Tylenol): 1,000 mg every 6 hours, no more than 4,000 mg in 24 hours (or 3,000 mg if your package says so, or if you have liver problems or drink alcohol regularly).
• Ibuprofen (Advil, Motrin): 400 mg every 8 hours with food, or naproxen (Aleve): 220 to 440 mg every 8 to 12 hours with food. These are fine to take after sinus surgery. Skip them if you have a stomach ulcer or kidney disease, or were told not to take them.
• You can alternate acetaminophen with ibuprofen or naproxen for better relief, keeping to each one’s dose limits.
• If we prescribed medicine, such as a pain medicine, a steroid or an antibiotic, take it exactly as directed. Most people do not need an antibiotic after sinus surgery.
• If you take aspirin or a blood thinner, follow your surgeon’s instructions on when to restart it.

What else helps?

• Sleep with your head raised on an extra pillow or two.
• A cold compress held loosely over the nose and cheeks can ease swelling in the first couple of days.
• Walking is fine and encouraged, starting right away.
• If you use CPAP, keep using it while you heal, starting the night of surgery.

When can I get back to normal?

• No heavy lifting, straining, bending over, strenuous exercise or anything tiring for 2 weeks.
• Do not blow your nose for 1 week. If you sneeze, sneeze with your mouth open.
• Some people go back to work in a couple of days, and some take up to a week.
• Do not travel for at least 1 week, and do not fly for 2 weeks.
• Do not swim until your surgeon says it is OK.

What happens at my first visit?

• Your sinuses are cleaned. At your first post-op visit, usually about a week after surgery, your surgeon uses numbing medicine, small instruments and gentle suction to remove crusts and clots so the sinuses heal open. It can be uncomfortable but is quick. Scar tissue is the most common problem after sinus surgery, and this cleaning (debridement) helps prevent it.
• Keep every cleaning appointment, even if you feel well. Some people need more than one.
• Check your coverage. Each insurance plan covers the cleaning differently. Some apply a deductible or do not cover it, so there may be an extra charge. If you have questions, ask your insurer about CPT code 31237.

When should I call?